Circulating cancer cells: The effect of surgical operations

Sellwood, R A; Kuper, S. W. A.; Wallace, N.; Burn, J. H.

doi:10.1002/bjs.1800521018

Cited by 12 publications

(6 citation statements)

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“…Cells were found more often in patients with undifferentiated tumours than in those with welldifferentiated ones, but a detailed statistical analysis (Sellwood, 1967) suggested that this was due entirely to the advanced nature of the disease in many patients with undifferentiated tumours. Engell (1955) obtained similar results, but concluded, without statistical analysis, that the most important factor affecting the incidence of cells was the degree of differentiation.…”

Section: Discussionmentioning

confidence: 98%

“…OF PATIENTS WITH STATED NO. OF suggest that cancer cells are found in small samples of peripheral blood in less than 10 per cent of patients (Sellwood, Kuper, Burn, and Wallace, 1964;West, Malmgren, and Chu, 19643 Christopherson, 1965; Moore and Sandberg, 19653 Nagy, 1969, and it seems unlikely that the findings of cells will be of any clinical or experimental value.…”

mentioning

confidence: 99%

“…They include the site from which blood is taken, the clinical stage of the disease, the degree of differentiation of the tumour, the site of the primary tumour, and surgical trauma and manipulation. The effect of surgical trauma has been considered in a previous publication (Sellwood, Kuper, Wallace, and Burn, 1965); the other factors are considered in this paper. …”

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confidence: 99%

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Factors affecting the finding of cancer cells in the blood

Sellwood

Kuper²,

Payne³

et al. 1969

Journal of British Surgery

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649reduction of wound infection, but reasons are given for believing that compared with improvements in air cleanliness these are relatively insignificant. 4.The only exception to variables other than clean air that might have contributed significantly to the improvement in sterility is an improved form of wound closure. How far this contributed to the final level of wound infection cannot be decided on the figures available.

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Section: Discussionmentioning

confidence: 98%

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confidence: 99%

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confidence: 99%

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Factors affecting the finding of cancer cells in the blood

Sellwood

Kuper²,

Payne³

et al. 1969

Journal of British Surgery

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“…Nevertheless, in clinical terms, not all circulating cancer cells give rise to metastases. Several reports have shown that patients with malignant cells in the venous blood fare no worse than those without (Engell, 1955;Roberts et al, 1961;Sellwood et al, 1965). Also, there is little evidence that manipulation per se can increase the number of malignant cells discharged into the circulation.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant cytotoxic liver perfusion for colorectal cancer

Taylor

Rowling

West

1979

Journal of British Surgery

103

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Colorectal liver metastases develop by malignant cells entering the portal venous circulation. A randomized prospective clinical trial was commenced in 1975 to assess the value of adjuvant umbilical vein cytotoxic perfusion (with 5-fluorouracil) following colorectal resection. One hundred and fifty-four patients without macroscopic liver secondaries have so far entered the trial. The mean age, sex, site and stage of the disease were similar in the control and perfusion groups and there was no statistically significant difference in postoperative complications or hospital stay (17.1 +/- 7.9 days control, 15.8 +/- 7.4 days perfusion group). So far, 23 deaths have occurred in the control group (20 due to recurrent disease) and 7 in the perfusion group (5 due to recurrent disease). Liver metastases were present in 13 control patients and 2 perfusion patients. These results show an encouraging trend and suggest that adjuvant cytotoxic liver perfusion may reduce the development of colorectal liver metastases and hence improve the subsequent prognosis.

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“…These researchers suggested that manipulation of the tumor may force malignant cells into the circulation and they initiated the so-called no touch-isolation technique [8]; however, not all circulating cancer cells give rise to metastases. Several reports have shown that patients with malignant cells in the portal venous blood fare no worse than those without them [9,10].…”

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Intraportal chemotherapy in colorectal carcinoma as an adjuvant modality

et al. 1987

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Liver metastases of colorectal origin arise from malignant cells entering the portal venous circulation. Four hundred sixty patients from 7 participating institutions have been entered in a prospective randomized trial to assess the value of adjuvant portal venous infusion to prevent liver metastases following curative colorectal cancer surgery. By preoperative randomization, patients were assigned to surgery alone (control arm) or to portal liver infusion with 5‐fluorouracil (5‐FU) (500 mg/m2 daily × 7, continuous infusion during the first 7 postoperative days) and mitomycin C (10 mg/m2, 24 hours postoperatively as a 2‐hour infusion). A portal venous catheter was placed through any side branch of the mesenteric venous system during laparotomy for the primary tumor. Using the transabdominal route, there have been no catheter‐related complications. Despite a large cumulative dose of 5‐FU given during the immediate postoperative period, the systemic side effects were minimal. Overall hospital mortality in this study was 1.85% and was not influenced by the adjuvant treatment. This rate is considerably lower than that reported by previous multicenter trials and by the surgical literature, and it indicates an advance in surgical technique and pre‐/postoperative patient management in this type of elective surgery.Three hundred seventy‐eight patients (187 controls, 191 infusion patients) are completely evaluable for recurrence and survival. After a median follow‐up of 24 months, 43 recurrences have been observed in the control group and 34 in the infusion group (p<0.05). Liver metastases were present in 18 control patients and in 14 infusion patients. Twenty‐five patients in the control group and 18 patients in the infusion group died of recurrent disease. Due to the low number of recurrences in this study, it is too early to draw survival conclusions.Several controlled trials using adjuvant portal infusion are in progress. They also showed the feasibility of this approach and they suggested that adjuvant cytotoxic liver infusion may reduce the incidence of liver metastases without significantly increasing morbidity and mortality. It is too early, however, to recommend adjuvant portal infusion outside a clinical trial setting and such treatment should still be restricted to well‐designed prospective protocols.

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Circulating cancer cells: The effect of surgical operations

Cited by 12 publications

References 12 publications

Factors affecting the finding of cancer cells in the blood

Factors affecting the finding of cancer cells in the blood

Adjuvant cytotoxic liver perfusion for colorectal cancer

Intraportal chemotherapy in colorectal carcinoma as an adjuvant modality

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